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General NPI Number Information
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NPI Number | 1003480799
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Entity Type | Organization
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Legal Business Name | CHILD PSYCHOLOGY OF LONG ISLAND
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 55 WEEKS ST
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City | BLUE POINT
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State | NY
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Zip | 11715-1516
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Country | US
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Telephone | 631-806-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 55 WEEKS ST
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City | BLUE POINT
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State | NY
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Zip | 11715-1516
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Country | US
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Telephone | 631-806-6889
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JACALYN BRUNO
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Credential | PSY.D.
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Telephone | 631-806-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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